Hip joint instrument and method

ABSTRACT

A surgical instrument for operating hip joint osteoarthritis in a human patient is provided. The hip joint comprises an acetabulum, being a part of the pelvic bone, and a caput femur, being the proximal part of the femoral bone. The surgical instrument is adapted to assist in the operating of the hip joint osteoarthritis from the abdominal side of the pelvic bone of said human patient.

This application is the U.S. national phase of International ApplicationNo. PCT/SE2010/050823, filed 12 Jul. 2010, which designated the U.S. andclaims the benefit of U.S. Provisional No. 61/229,755, filed 30 Jul.2009; 61/229,738 filed 30 Jul. 2009; 61/229,739 filed 30 Jul. 2009;61/229,743 filed 30 Jul. 2009; 61/229,745 filed 30 Jul. 2009; 61/229,746filed 30 Jul. 2009; 61/229,747 filed 30 Jul. 2009; 61/229,748 filed 30Jul. 2009; 61/229,751 filed 30 Jul. 2009; 61/229,752 filed 30 Jul. 2009;61/229,761 filed 30 Jul. 2009; 61/229,767 filed 30 Jul. 2009; 61/229,778filed 30 Jul. 2009; 61/229,786 filed 30 Jul. 2009; 61/229,789 filed 30Jul. 2009; 61/229,796 filed 30 Jul. 2009; 61/229,735 filed 30 Jul. 2009;and which claims priority to Swedish Application Nos.: 0900981-2 filed10 Jul. 2009; 0900957-2 filed 10 Jul. 2009; 0900958-0 filed 10 Jul.2009; 0900959-8 filed 10 Jul. 2009; 0900960-6 filed 10 Jul. 2009;0900962-2 filed 10 Jul. 2009; 0900963-0 filed 10 Jul. 2009; 0900965-5filed 10 Jul. 2009; 0900966-3 filed 10 Jul. 2009; 0900968-9 filed 10Jul. 2009; 0900969-7 filed 10 Jul. 2009; 0900970-5 filed 10 Jul. 2009;0900972-1 filed 10 Jul. 2009; 0900973-9 filed 10 Jul. 2009; 0900974-7filed 10 Jul. 2009; 0900976-2 filed 10 Jul. 2009 and 0900978-8 filed 10Jul. 2009, the entire contents of each of which are hereby incorporatedby reference.

FIELD OF INVENTION

The present invention relates generally to a surgical instrument for usein treating of hip osteoarthritis in a human patient.

BACKGROUND

Hip Osteoarthritis is a syndrome in which low-grade inflammation resultsin pain in the hip joints, caused by abnormal wearing of the Cartilagethat acts as a cushion inside if the hip joint. This abnormal wearing ofthe cartilage also results in a decrease of the joints lubricating fluidcalled Synovial fluid. Hip Osteoarthritis is estimated to affect 80% ofall people over 65 years of age, in more or less serious forms.

The present treatments for hip osteoarthritis comprises NSAID drugs,local injections of Hyaluronic acid or Glucocorticoid to helplubricating the hip joint, and replacing parts of the hip joint with aprosthesis through hip joint surgery.

Replacing parts of the hip joint is one of the most common surgeries todate performed at hundreds of thousand of patients in the world everyyear. The most common method comprises placing a metal prosthesis inFemur and a plastic bowl in Acetabulum. This operation is done through alateral incision in the hip and upper thigh, through Fascia Lata and thelateral muscles of the thigh. To get access to the joint, the supportingFibrous Capsule attached to Femur and Ilium needs to be penetrated,making it difficult to get a fully functional joint after the surgery.Femur is then cut at the neck with a bone saw and the prosthesis isplaced in femur either with bone cement or without. Acetabulum isslightly enlarged using an Acetabular reamer, and the plastic bowl ispositioned using screws or bone cement.

The surgery typically requires one week of hospitalization due to theincreased risk of infection. The recovery process is on average about 6weeks, but even after that the patient should not perform any physicalactivates that places large strain on the joint.

SUMMARY

A first object is to provide a surgical instrument for operating hipjoint osteoarthritis in a human patient. The hip joint comprises anacetabulum being a part of the pelvic bone, and a caput femur being theproximal part of the femoral bone. The surgical instrument comprises anabdominal portion insertable through an incision in the skin in theabdominal region and adapted to be placed between the incision in theabdominal region and the pelvic bone when the instrument is in use, anda pelvic portion connected to the abdominal portion, being partiallyinsertable through a hole in the pelvic bone from the abdominal side ofthe pelvic bone, when the instrument is in use, wherein a portion of thepelvic portion is adapted to operate at least partially in a surgicallycreated hole in the pelvic bone.

According to one embodiment the surgical instrument is further adaptedto operate through a hole in the pelvic bone of said human patient. Forthis purpose the instrument could be adapted to be bent, by means of: afixed angle, an adjustable angle, a parallel displaced part or section,at least one gear wheel or at least one universal joint. It isfurthermore conceivable that the surgical instrument is adapted to becurved in such a way that it is adapted to be introduced through theskin and further into the hole in the pelvic bone from the abdominalside thereof and further into the hip joint.

According to one embodiment the length of the surgical instrument isadapted to reach the hip joint from the abdominal side of said pelvicbone. The surgical instrument could further comprise a gripping end andan end reaching the hip joint, in which case the distance between saidgripping end and a part of said surgical instrument adapted to be bentcould be adapted for operating in a hip joint from the abdominal side ofsaid pelvic bone. It is also conceivable that the length between saidgripping end and said end reaching the hip joint is adapted foroperating in a hip joint from the abdominal side of said pelvic bone.

According to another embodiment the surgical instrument is a speciallaparoscopic instrument introduced into the abdomen and further down tothe pelvic bone on the opposite side of the acetabulum and introducedinto the hip joint. The instrument could further comprise a grippingend, placed outside the abdominal wall when in use, and a hip joint endadapted to be placed in an area of the hip joint. The length of theinstrument could be adapted to reach from the gripping end and into thehip joint via a surgically created hole in the pelvic bone and whereinthe longitudinal extension of the instrument comprises at least onebend, for the instrument to reach, when used as a special laparoscopicinstrument to operate the hip joint, from the gripping end into theabdomen and further down to the pelvic bone on the opposite side of theacetabulum and be introduced into the hip joint through the surgicallycreated hole in the pelvic bone.

According to yet another embodiment the surgical instrument is a specialpelvic instrument adapted to be introduced into the pelvic region andfurther to the pelvic bone on the opposite side of the acetabulum, andintroduced into the hip joint via a surgically created hole in thepelvic bone. The instrument could further comprise a gripping end,placed outside the skin above the pelvic region when in use, and a hipjoint end adapted to be placed in an area of the hip joint, wherein thelength of said instrument is adapted to reach from the gripping end andinto the hip joint, and wherein the longitudinal extension of saidinstrument comprises at least one bend, for the instrument to reach,when used as special pelvic instrument to operate the hip joint, fromthe gripping end into the pelvic region and further down to the pelvicbone on the opposite side of the acetabulum, and introduced into the hipjoint through the surgically created hole in the pelvic bone.

According to yet another embodiment, the surgical instrument could beadapted to be a special retroperitoneal instrument introduced into thebody just above the inguinal region following the pelvic bone down tothe opposite side of the acetabulum and thereafter introduced into thehip joint via a surgically created hole in the pelvic bone. Theinstrument could comprise a gripping end, placed outside the skin abovethe pelvic region when in use, and a hip joint end adapted to be placedin an area of the hip joint. The length of the instrument is adapted toreach from the gripping end and into the hip joint and the longitudinalextension of said instrument comprises at least one bend, for theinstrument to reach, when used as special retroperitoneal instrument tooperate the hip joint, from the gripping end following the pelvic boneand further down to the pelvic bone on the opposite side of theacetabulum and introduced into the hip joint through the surgicallycreated hole in the pelvic bone.

The surgical instrument according to any of the embodiments couldcomprise at least one holding part and a mechanical element adapted tobe fitted to the at least one holding part of the instrument. Thesurgical instrument could be adapted to perform a function during anoperation of the hip joint. The mechanical element could in turn beadapted to be part of an instrument adapted to be used for at least oneof the following functions; drilling, reaming, cooling, heating,flushing, introducing a fluid, sucking, inserting at least one part,connecting at least one part, fixating at least one part, inserting amould, filling a mould, injecting, lubricating, viewing, opticallydisplaying, placing screws, placing adhesive, placing bone cement.

The surgical instrument could have a distance between the gripping endand the bend that is at least 10 cm, it is furthermore conceivable thatthe distance between the gripping end and the bend is at least 20 cm. Itis furthermore conceivable that the distance between the gripping endand the bend is at least 30 cm. It is furthermore conceivable that thedistance between the gripping end and the bend is at least 40 cm. It isfurthermore conceivable that the distance between said gripping end andsaid bend is at least 50 cm.

According to one embodiment the surgical instrument comprises a bend,and wherein the bend is bent with an angle of at least 10 degrees, thebend is bent with an angle of at least 20 degrees or the bend is bentwith an angle of at least 30 degrees, or the bend is bent with an angleof at least 40 degrees, or the bend is bent with an angle of at least 50degrees, or the bend is bent with an angle of at least 60 degrees.

According to one embodiment the of the surgical instrument, the distancebetween the bend and the hip joint end of the instrument is at least 2cm, according to another embodiment the distance between the bend andthe hip joint end of the instrument is at least 4 cm, according to yetanother embodiment the distance between the bend and the hip joint endof the instrument is at least 6 cm, according to yet another embodimentthe distance between the bend and the hip joint end of the instrument isat least 8 cm, according to yet another embodiment the distance betweenthe bend and the hip joint end of the instrument is at least 10 cm,according to yet another embodiment the distance between the bend andthe hip joint end of the instrument is at least 12 cm, according to yetanother embodiment the distance between the bend and the hip joint endof the instrument is at least 14 cm,

APPLICATIONS OF THE INSTRUMENT

The surgical instrument could be adapted for a number of applications.According to a first embodiment the surgical instrument is adapted tocreate a through-going hole in the pelvic bone placed in the acetabulumarea from the abdominal side of the pelvic bone of said human patient.According to this embodiment the surgical instrument could comprise: adriving member, a bone contacting organ in connection with said drivingmember, and an operating device adapted to operate said driving member.

According to one embodiment the surgical instrument is adapted to reamthe acetabulum and or the caput femur of said human patient. Accordingto this embodiment the surgical instrument could be adapted to beexpandable, thus allowing the surgical instrument to be inserted througha hole in the pelvic bone smaller than the area possible to ream usingsaid surgical instrument. The surgical instrument adapted to ream couldcomprise: a driving member, a bone contacting organ in connection withsaid driving member, and an operating device, adapted to operate saiddriving member. The bone contacting organ could comprise at least one ofthe materials: titanium, ceramics or stainless steel. The operatingdevice could be: electrically operated hydraulically operated andcomprise at least one camera and/or at least one light source.

According to one embodiment the surgical instrument is adapted to coolan area of the hip joint or the pelvic bone. The cooling could beprovided using a cooling fluid and could be provided before, during orafter the creation of a hole in the pelvic bone. It is also conceivablethat the cooling is provided before, during or after a reamingoperation.

According to one embodiment the surgical instrument is adapted toprovide a fluid to an area of the pelvic bone or the hip joint. Thefluid could be adapted to clean or sterilize an area of the pelvic boneor an area of the hip joint.

According to one embodiment the surgical instrument is adapted toprovide suction to an area of the pelvic bone or the hip joint. Thesurgical instrument adapted to provide suction could further be adaptedto transport body fluids, parts of bone, cartilage or a fluid providedduring the hip joint surgery.

According to one embodiment the surgical instrument is adapted tointroduce prosthesis or at least one prosthetic part into the hip joint.The prosthesis or prosthetic part could be acetabulum prosthesis or apart of acetabulum prosthesis or caput femur prosthesis or a part ofcaput femur prosthesis.

According to one embodiment the surgical instrument is adapted toconnect at least two prosthetic parts to each other after insertion intothe hip joint. The at least two prosthetic parts could comprises atleast two artificial caput femur surface parts or at least twoartificial acetabulum surface parts. The fixation could be done using atleast one of: screws, form fitting, welding, adhesive, sprint, band, orother mechanical connecting members.

According to one embodiment the surgical instrument is adapted to fixatea hip joint surface, or a part of a hip joint surface, to the pelvicbone or the femur bone. The fixation could be done using at least oneof: screws, form fitting, welding, adhesive, sprint, band, or othermechanical connecting members.

According to one embodiment the surgical instrument is adapted tointroduce a mould or at least one sealing member into the hip joint. Themould or sealing member could be adapted to be resorbable by the humanbody or melt after having served its purpose as mould. According to thisembodiment the surgical instrument could comprise gripping means forgripping said mould or sealing member.

According to one embodiment the surgical instrument is adapted to injecta fluid, adapted to harden to provide an artificial hip joint surface inthe hip joint, into a mould or a sealed area of the hip joint. Accordingto this embodiment the surgical instrument could comprise at least onecontainer, a fluid injecting member in connection with said mould, and afluid driving member in fluid connection with said fluid injectingmember and said at least one container.

According to one embodiment the surgical instrument comprises at leasttwo containers adapted to hold two different fluids, and a mixing unitadapted to mix said fluids contained in said at least two containers.

According to one embodiment the surgical instrument is adapted tointroduce adhesive or bone cement into the hip joint. According to thisembodiment the surgical instrument could comprise: at least onecontainer, a fluid injecting member, and a fluid driving member in fluidconnection with said fluid injecting member and said at least onecontainer. According to one embodiment the surgical instrument comprisesat least two containers adapted to hold two different fluids, and amixing unit adapted to mix said fluids contained in said at least twocontainers.

According to one embodiment the surgical instrument is adapted to placeor fixate fixating elements to the pelvic bone or a prosthetic part inthe pelvic region. The fixating elements could comprise: at least onescrew, at least one plate and/or at least one nut.

According to one embodiment the surgical instrument comprises at leastone camera, at least one light source or an x-ray tube or x-raydetector.

According to one embodiment the surgical instrument is adapted to injecta lubricating fluid into the hip joint, in which case the surgicalinstrument could comprise: at least one container, a fluid injectingmember, and a fluid driving member in fluid connection with said fluidinjecting member and said at least one container. The lubricating fluidis preferably a biocompatible lubricating fluid, such as hyaluronicacid.

Please note that any embodiment or part of embodiment, feature, method,associated system, part of system described herein may be combined inany way.

BRIEF DESCRIPTION OF THE DRAWINGS

The embodiments are now described, by way of example, with reference tothe accompanying drawings, in which:

FIG. 1 shows a hip joint in section,

FIG. 2 shows a lateral view of a conventional hip joint surgery,

FIG. 3 shows an artificial caput femur being used in conventionalsurgery,

FIG. 4 shows a frontal view of the body of a human patient,

FIG. 5 shows a frontal view of the body of a human patient,

FIG. 6 shows a frontal view of the body of a human patient,

FIG. 7 shows a lateral view of the body of a human patient in section,

FIG. 8 a shows the creation of a hole through the collum femur, in alength axis thereof,

FIG. 8 b shows mechanical instruments adapted to be placed on anelongated member placed in a hole in collum femur,

FIG. 9 a shows the placement of an elongated member through the pelvicbone,

FIG. 9 b shows the elongated member in further detail,

FIG. 10 a shows an instrument with a parallel displaced part or section,

FIG. 10 b shows an instrument with two joints,

FIG. 10 c shows an instrument with a flexible part or section,

FIG. 11 shows an instrument comprising a worm gear,

FIG. 12 shows an instrument comprising a universal joint,

FIG. 13 shows an instrument comprising a gripping member,

FIG. 14 shows an instrument adapted to create a hole in the pelvic bone,

FIG. 15 shows an instrument adapted to create a hole in the pelvic bonein further detail,

FIG. 16 shows an instrument adapted to create a hole in the pelvic bonecomprising a parallel displaced part or section,

FIG. 17 adapted to create a hole in the pelvic bone comprising twojoints,

FIG. 18 shows an instrument adapted to create a hole in the pelvic bonecomprising a flexible part or section,

FIG. 19 a shows an instrument adapted to create a hole in the pelvicbone in further detail,

FIG. 19 b shows an instrument adapted to create a hole in the pelvicbone in further detail,

FIG. 20 shows an instrument adapted to create a hole in the pelvicaccording to another embodiment,

FIG. 21 shows an instrument adapted to create a hole in the pelvicaccording to another embodiment,

FIG. 22 shows an instrument adapted to create a hole in the pelvicaccording to another embodiment,

FIG. 23 shows an instrument adapted to create a hole in the pelvic bonecomprising two gear wheels,

FIG. 24 shows an instrument adapted to create a hole in the pelvic bonecomprising a worm gear,

FIG. 25 shows an instrument adapted to create a hole in the pelviccomprising a universal joint,

FIG. 26 shows an instrument adapted to create a hole in the pelvic bonecomprising a chain,

FIG. 27 shows an instrument adapted to create a hole in the pelvic bonecomprising a chain according to another embodiment,

FIG. 28 a shows an instrument adapted to create a hole in the pelvicaccording to another embodiment,

FIG. 28 b shows an instrument adapted to create a hole in the pelvicaccording to another embodiment,

FIG. 29 shows an instrument adapted to create a hole in the pelvic bonein further detail,

FIG. 30 shows an instrument adapted to create a hole in the pelvic bonecomprising a cover,

FIG. 31 shows an instrument adapted to ream, in a first position,

FIG. 32 shows an instrument adapted to ream, in a second position,

FIG. 33 shows an instrument adapted to ream, from underneath,

FIG. 34 shows an instrument adapted to ream, when reaming,

FIG. 35 shows an instrument adapted to ream, comprising a paralleldisplaced part or section,

FIG. 36 shows an instrument adapted to ream comprising two joints,

FIG. 37 shows an instrument adapted to ream comprising a flexible partor section,

FIG. 38 shows an instrument adapted to ream, in further detail,

FIG. 39 shows an instrument adapted to ream, comprising two gear wheels,

FIG. 40 shows an instrument adapted to ream, comprising a worm gear,

FIG. 41 shows an instrument adapted to ream, comprising a universaljoint,

FIG. 42 shows an instrument adapted to ream, comprising a chain,

FIG. 43 shows an instrument adapted to ream, comprising a chain,according to another embodiment,

FIG. 44 shows an instrument adapted to ream, according to anotherembodiment,

FIG. 45 shows an instrument adapted to ream, according to anotherembodiment,

FIG. 46 shows an instrument adapted to ream according to anotherembodiment,

FIG. 47 shows an instrument adapted to ream, comprising a cover,

FIG. 48 shows an instrument adapted for flushing, cooling and/orsucking,

FIG. 49 shows an instrument for gripping or handling,

FIG. 50 shows an instrument for gripping or handling, comprising aparallel displaced part or section,

FIG. 51 shows an instrument for gripping or handling, comprising twojoints,

FIG. 52 shows the hip joint in section,

FIG. 53 shows the insertion of prosthetic parts is a surgical method,

FIG. 54 shows the insertion of prosthetic parts is a laparoscopicmethod,

FIG. 55 shows the insertion of prosthesis, through a hole in the pelvicbone,

FIG. 56 a shows the insertion of prosthetic parts, through a hole in thepelvic bone,

FIG. 56 b shows the connecting of prosthetic parts, through a hole inthe pelvic bone,

FIG. 56 c shows prosthetic parts,

FIG. 57 shows an instrument adapted to fixate a hip joint surface,

FIG. 58 shows an instrument adapted to inject a fluid into a hip joint,

FIG. 59 a shows an instrument adapted to insert a mould or a sealingmember into a hip joint,

FIG. 59 b shows an instrument adapted to insert a mould or a sealingmember into a hip joint, in section,

FIG. 59 c shows an instrument adapted to insert a mould or a sealingmember into a hip joint, comprising a flexible part or section,

FIG. 60 a shows an instrument adapted to insert a mould or a sealingmember into a hip joint,

FIG. 60 b shows an instrument adapted to insert a mould or a sealingmember into a hip joint, comprising a parallel displaced part orsection,

FIG. 60 c shows an instrument adapted to insert a mould or a sealing,comprising two joints,

FIG. 61 shows the insertion of a mould or a sealing member, through thepelvic bone,

FIG. 62 shows the placing of a second sealing member,

FIG. 63 a shows the insertion of a mould or a sealing member, throughthe femoral bone,

FIG. 63 b shows the insertion of a mould or a sealing member, throughthe femoral bone,

FIG. 63 c shows the insertion of a mould or a sealing member, throughthe femoral bone,

FIG. 64 shows the insertion of a mould or a sealing member, through thehip joint capsule,

FIG. 65 shows the injection of fluid into a mould, through the hipjoint,

FIG. 66 shows the injection of fluid into a mould, through the femoralbone,

FIG. 67 shows the injection of fluid into a mould, through the hip jointcapsule,

FIG. 68 shows the hip joint in section, after a fluid has been injected,

FIG. 69 shows a lateral view of a human patient in section, with aninstrument for injecting a fluid,

FIG. 70 shows an instrument for injecting a fluid in further detail,

FIG. 71 a shows a prosthetic part being used to close a hole in a pelvicbone,

FIG. 71 b shows how sections of a prosthetic part is used as supportagainst the edges of the hole in a pelvic bone,

FIG. 72 shows the insertion of a prosthetic part in a hole in a pelvicbone,

FIG. 73 shows how screws are being used to fixate a bone plug or aprosthetic part in a hole in a pelvic bone of a human patient,

FIG. 74 a shows an instrument for fixating fixation members to an areaof the pelvic bone,

FIG. 74 b shows an instrument for fixating fixation members to an areaof the pelvic bone,

FIG. 74 c shows an instrument for fixating fixation members to an areaof the pelvic bone,

FIG. 75 shows an instrument comprising an arthroscopic camera,

FIG. 76 shows an instrument for injecting a lubricating fluid.

DETAILED DESCRIPTION

In the following a detailed description of embodiments will be given. Inthe drawing figures, like reference numerals designate identical orcorresponding elements throughout the several figures. It will beappreciated that these figures are for illustration only and are not inany way restricting the scope. Thus, any references to direction, suchas “up” or “down”, are only referring to the directions shown in thefigures. Also, any dimensions etc. shown in the figures are forillustration purposes.

Please note that any embodiment or part of embodiment as well as anymethod or part of method could be combined in any way. All examplesherein should be seen as part of the general description and thereforpossible to combine in any way in general terms.

FIG. 1 shows the hip joint of a human patient in section. The hip jointcomprises a caput femur 5 placed at the very top of collum femur 6 whichis the top part of the femur bone 7. The caput femur is in connectionwith the acetabulum 8 which is a bowl shaped part of the pelvic bone 9.Both the caput femur surface 10 and the acetabulum surface 11 is coveredwith articular cartilage 13 which acts as a cushion in the hip joint. Inpatients with hip joint osteoarthritis, this articular cartilage 13 isabnormally worn down sometimes due to a low grade inflammation. The hipjoint is surrounded by the hip joint capsule 12 which provides supportfor the joint and hinders luxation. After conventional hip jointsurgery, penetrating the hip joint capsule 12, the capsule 12 isdramatically weakened due to the limited healing possibilities of itsligament tissue. By performing hip joint surgery without damaging thehip joint capsule 12 the patient can fully recover and place equalamount of strain on an artificial joint as is possible on a natural one.

FIG. 2 shows a lateral view of a conventional hip joint surgery where anincision 112 is made in the thigh 113 enabling the surgeon to reach thefemur bone 7 on which the caput femur 5 is located. In a conventionalhip joint surgery the hip joint is accessed through the hip jointcapsule.

FIG. 3 shows the placing of an artificial caput femur surface 45 on thecaput femur 5 in conventional surgery.

FIG. 4 shows a frontal view of the body of a human patient. A surgicalmethod of operating the hip joint from the opposite side fromacetabulum, is according to a first embodiment performed starting withan incision 1 in the abdominal wall of the human patient. The incision 1passes through the abdominal wall sometimes including the rectusabdominis and including peritoneum in to the abdomen of the humanpatent. In a second embodiment the incision 2 is conducted through theskin and into the pelvic area, below peritoneum. According to a thirdembodiment the incision 3 is performed just between Illium and thesurrounding tissue, an incision 3 which could enable the pelvic bone tobe dissected with very little penetration of fascia and muscular tissue.According to a fourth embodiment the incision 4 is made in the inguinalregion or slightly above. In all of the four embodiments the tissuesurrounding the pelvic bone 9 in the area opposite to acetabulum isremoved or penetrated which enables the surgeon to reach the pelvic bone9.

FIG. 5 shows a frontal view of the body of a human patient. Alaparoscopic method of operating the hip joint, from the opposite sidefrom acetabulum, is according to a first embodiment performed startingwith making small incisions 14 in the abdominal wall of the humanpatient. The small incisions enable the surgeon to insert laparoscopictrocars into the abdomen of the human patient. According to the firstembodiment the incisions 14 passes through the abdominal wall includingthe peritoneum in to the abdomen of the human patent. According to asecond embodiment the small incisions 15 is conducted through the skinand in to the pelvic area, below peritoneum. According to a thirdembodiment the small incisions 16 is performed just between Illium andthe surrounding tissue, an incision 16 which could enable the pelvicbone to be dissected with very little penetration of fascia and musculartissue. According to a fourth embodiment the incision 17 is made in theinguinal channel. In all of the four embodiments the tissue surroundingthe pelvic bone 9 in the area opposite to acetabulum 8 is removed orpenetrated which enables the surgeon to reach the pelvic bone 9.

After the incision is made the surgical instruments according to any onthe embodiments below can enter the human buoy and be used to assist thesurgeon in the operation of the hip joint osteoarthritis.

FIG. 6 shows a frontal view of the body of a human patient, illustratingthe instruments 34, 35, 36 assisting in the method of operating the hipjoint from the opposite side from acetabulum 8, the hip joint comprisingthe acetabulum 8 and the caput femur 5. The small incisions 14 in theabdominal wall of the human patient allows the insertion of laparoscopictrocars 33 a,b,c into the body of the patients. Whereafter one or morecamera 34, a surgical instrument 35 adapted to create a hole in thepelvic bone 9, or instruments 36 for introducing, placing, connecting,attaching, creating or filling prosthesis or prosthetic parts, can beinserted into said body through said laparoscopic trocars 33 a,b,c. manydifferent placements of the trocars is possible. The portions of theinstruments adapted to be placed in the abdominal area are the abdominalportions 250, and the portions adapted to at least partially be placedinside of the pelvic bone is the pelvic portions 251 throughout thisapplication.

FIG. 7 shows a lateral view of the body of a human patient, with the hipjoint shown in section in further detail. The hip joint comprises acaput femur 5 placed at the very top of collum femur 6 which is the toppart of the femur bone 7. The caput femur is in connection with theacetabulum 8 which is a bowl shaped part of the pelvic bone 9.Laparoscopic trocars 33 a,b,c is being used to reach the hip joint 39with one or more camera 34, a surgical instrument adapted to create ahole in the pelvic bone 35, or instruments 36 for introducing, placing,connecting, attaching, creating or filling prosthesis or prostheticparts. The portions of the instruments adapted to be placed in theabdominal area are the abdominal portions 250, and the portions adaptedto at least partially be placed inside of the pelvic bone is the pelvicportions 251 throughout this application.

FIG. 8 a shows a human patient in section when an incision 1 is made inthe abdominal wall of the human patient, and a second incision 200 inmade in the lateral part of the left thigh. A drilling member 201 hasbeen introduced through the incision 200 in the thigh, penetrating thefascia lata, and reaching the femoral bone 7. After the drilling member201 has made contact with the femoral bone 7, a drilling process isstarted which creates a hole 205 in the cortical bone of the femoralbone 7 and into the cancellous bone of the femoral bone 7, the hole 205then propagates along a length axis of the collum femur 6 and eventuallyreaches the caput femur 5, from the inside thereof. The caput femur 5 ispenetrated from the inside and the drilling member 201 continues to theacetabulum 8 which is a bowled shaped part of the pelvic bone 9. Thedrilling member 201 penetrates the pelvic bone 9 and continues into theabdominal area of the human patient. The drilling member 201 is thenretracted from the hole 205 which leaves a hole 201 reaching from thelateral side of the thigh, to the area of the hip joint. The drillingmember 201 is powered by an operating device 202 which could be anelectrically, hydraulically or pneumatically powered operating device202.

After the hole 205 has been created along a length axis of the collumfemur 6, a force transferring member 206 is inserted through the hole205. The force transferring member 206 could be a tubular or solidshaft, or a flexible member such as a wire.

FIG. 8 b shows the hip joint in section when a force transferring member206 has been inserted through the hole 205. The force transferringmember 206 comprises a tool fixating member 218 positioned on the end ofthe force transferring member 206. The tool fixating member 218 couldcomprise a screw-thread or a bayonet joint which could be activated tofixate a tool 224,225,226 to the force transferring member 206, by theturning of said force transferring member by means of manualmanipulation or an operating device 207. FIG. 5 further shows a tool forcreating a hole 224 in the pelvic bone 9, a tool 225 for manipulating animplantable device such as a prosthesis or a prosthetic part, and a tool226 for reaming the acetabulum 8 and/or the caput femur 5. The toolscomprise a fixating member 219 which acts together with the toolfixating member 218 on the force transferring member 206 to fixate thetool 224,225,226 to the force transferring member 206. The tools224,225,226 is inserted through the incision in the abdominal region, asshown in FIG. 4. where a tool 224 for creating a hole in the pelvic bone9 is inserted through an incision 1 in the abdominal region of the humanpatient using a tool introducing member 203. The force transferringmember 206 according to any of the embodiments could be used as apositioning shaft, for positioning, centering and guiding a tool or amedical device, such as a prosthetic part.

FIG. 9 a shows an embodiment in which a hole is created in two differentparts of the pelvic bone 9. A drilling member 201 is first brought tothe left part of the pelvic bone 9′ for creating a hole in the left partof the pelvic bone 9. The drilling member thereafter continues throughthe abdominal and/or pelvic region and reaches the right part of thepelvic bone 9″ where a second hole is created reaching into the hipjoint. The drilling member 201 is powered by an operation device 202,which could be a powered operation device, such as an electrical,hydraulic or pneumatic motor. According to another embodiment thedrilling member 201 is manually operated. The drilling member furthercomprises a protective sleeve 240 adapted to protect the organs andtissue of the body from the drilling member 201 when advancing thedrilling member through the abdominal and/or the pelvic region. Thecreation of two holes enables a very stable position of an elongatedmember which could be placed through the two holes for delivering anaction to the hip joint or its surroundings.

FIG. 9 b shows the drilling member in further detail, first in a statein which the protective sleeve 240 is advanced for covering the drillingmember 201 and thereby protecting the organs and tissue of the humanbody from the drilling member. Below, the drilling member is shown in asecond state, in which the protective sleeve 240 is refracted andthereby exposing the drilling member 201 and enabling the drillingmember 201 to create a hole in bone.

After the hole has been created along a force transferring member orelongated member, according to any of the embodiments herein, could beinserted through the holes for delivering an action to the hip joint orits surroundings. The force transferring member could be a tubular orsolid shaft, or a flexible member such as a wire.

To reach the pelvic bone or the hip joint from the abdominal side, it isconceivable that the surgical instrument is adapted to be bent.

FIG. 10 a shows the surgical instrument according to a first embodimentwherein the surgical instrument comprises a handling portion 77 and aparallel displaced part or section 79, which increases the reach of theinstrument and facilitates the reaching of the pelvic bone or the hipjoint through from the abdominal side of the pelvic bone, or through ahole in the pelvic bone from the opposite side from acetabulum.

FIG. 10 b shows the surgical instrument according to a second embodimentwherein the surgical instrument comprises two angle adjusting members 80a,b. The angle adjusting members could be adapted to be flexible foradjusting of the angle during surgery or fixed in a preset position.

FIG. 10 c shows the surgical instrument according to a third embodimentwherein the surgical instrument comprises a flexible part or section300, enabling the surgical instrument to be very precisely adjusted toreach the pelvic bone or the hip joint from the abdominal side of thepelvic bone. The stiffness of said flexible part or section 300 couldrange from completely flexible to completely stiff to fit thesurroundings of the particular operation.

FIG. 11 shows the surgical instrument according to a fourth embodimentwherein the surgical instrument is adapted to be bent by means ofgearwheels 154. The gearwheel construction can be such that the angledcould be changed during the surgery, or it could be adapted to be fixedin a specific angle.

FIG. 12 shows the surgical instrument according to a fifth embodimentwherein the surgical instrument is adapted to be bent by means of auniversal joint 155. The universal joint construction can be such thatthe angled could be changed during the surgery, or it could be adaptedto be fixed in a specific angle.

FIG. 13 shows the surgical instrument according to a sixth embodiment,wherein the surgical instrument comprises a gripping portion 76 and ahandling portion 77. According to the embodiments shown in FIG. 40 a theinstrument further comprises a rotation element 78 that enables thegripping part 76 to rotate in relation to the handling part 77, howeverit is equally conceivable that the surgical instrument lacks thisrotation element 78.

The surgical instrument is generally adapted to assist the surgeon in asurgical or laparoscopic method of operating hip joint osteoarthritis.Embodiments of the surgical instrument for performing specific task willnow be described with reference to the accompanying drawings.

FIG. 14 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9. According to a first embodiment, the instrumentcomprises a driving member 21 a, b. The driving member 21 a,b could be ashaft, a rod, a belt, a chain or any other element suitable fortransferring force or torque. The instrument also comprises a bonecontacting organ 22 which is adapted to create the hole 18, 20 in thepelvic bone 9. The bone contacting organ 22 could have a sawing,drilling or milling effect using sharp objects; it is furthermoreconceivable that said bone contacting organ 22 creates a hole usingwater, abrasive fluids, laser or radiation. The instrument alsocomprises an operating device 23 a adapted to operate the driving member21 a,b. The operating device could comprise an electrical, hydraulic,mechanical, pneumatic or magnetic engine and it could be adapted tocreate a rotating, oscillating, vibrating or repetitive movement.

FIG. 15 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a second embodiment in which theoperating device 23 b is placed in direct connection with the bonecontacting organ 22. In this case the operating device 23 b also servesas driving member. In this construction a handle portion 24 could beattached to the instrument, facilitating the surgeons handling of saidsurgical instrument. To improve the reach of the surgical instrument thehandle portion 24 could be attached perpendicular to the hole-creatingdirection 25 of the surgical instrument, it is furthermore conceivablethat the handle portion 24 is bent by means of a parallel displaced partor section, a fixed angle, an adjustable angle or a flexible part orsection.

FIG. 16 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a third embodiment wherein the instrumentfurther comprises a parallel displaced part or section 26. The paralleldisplaced part or section 26 improves the reach of the instrument andenables the creation of a hole 18 in the pelvic bone 9 from the oppositeside from acetabulum 8. According to the embodiment shown in FIG. 16 theparallel displaced part or section 26 has a telescopic function by meansof the parallel displaced part or section 26 being divided in to a firstand second part 27 a, b, wherein the second part 27 b can slide in andout of the first part 27 a.

FIG. 17 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a fourth embodiment wherein saidinstrument comprises a driving member 28 a,b,c with two angle adjustingmembers 29 a,b. The angle adjusting members 29 a,b could be adjustablefor varying the angle of said driving member 28 a,b,c or fixed in anangle suitable for creating a hole in the pelvic bone 9 from theopposite side from acetabulum 8. In another embodiment (not shown) thepart of the driving member 28 c in connection with the bone contactingorgan 22 could be very short enabling the instrument to operate veryclose to the pelvic bone 9 when creating a hole 18 in said pelvic bone9.

FIG. 18 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a fifth embodiment wherein the drivingmember 30 is flexible, enabling said driving member 30 to be veryprecisely adjusted to create a hole 18 in the pelvic bone 9 of thepatient. The stiffness of said driving member 30 could range fromcompletely flexible to completely stiff to fit the surroundings of theparticular operation.

FIG. 19 a shows the bone contacting organ according to a firstembodiment wherein the bone contacting organ 22 a is adapted to create abone plug 31. The bone plug 31 could be adapted to be replaced into saidhole 18 after the surgical or laparoscopic steps performed in the hipjoint has been concluded.

FIG. 19 b shows the bone contacting organ according to the firstembodiment in section wherein the bone contacting organ 22 a is adaptedto create a bone plug 31. According to this embodiment the instrumentfurther comprises at least one holding member 150 for holding said boneplug in place after it has been removed from the pelvic bone of thehuman patient.

FIG. 20 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a sixth embodiment wherein saidinstrument comprises a stabilizing drill 151 adapted to stabilize theinstrument when creating said hole in the pelvic bone from the oppositeside from acetabulum.

FIG. 21 shows the bone contacting organ according to a second embodimentwherein the bone contacting organ 22 b is adapted to create small piecesof bone 32 when creating said hole 18 in the pelvic bone 9. The smallpieces of bone 32 could be transported from the area and out of the bodyusing vacuum power or a hydraulic transport system.

FIG. 22 shows a pneumatic, vacuum powered or a hydraulic transportsystem 152 for transport of said small pieces of bone. The same system152 or an additional one could be for rinsing or cooling purposes whencreating said hole in the pelvic bone 9.

FIG. 23 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a seventh embodiment, wherein the drivingmember 30 comprises at least one worm gear 153 which enables the drivingmember 30 to be angled. It is also conceivable that said angle could beadjustable in which case said worm gear has a radius (not shown).

FIG. 24 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to an eight embodiment, wherein the drivingmember 30 comprises at least one gear wheel 154. In the embodiment shownthe two gear wheels 154 is constructed to enable the adjusting of anangle of the driving member 30.

FIG. 25 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a ninth embodiment, wherein the drivingmember 30 comprises at least one universal joint 155, said universaljoint enabling the adjusting of an angle of said driving member 30.

FIG. 26 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a tenth embodiment, wherein the drivingmember 30 comprises at least one chain 156.

According the any of the embodiments above the driving member couldcomprise a housing 157 shown in FIGS. 23, 24 and 26. Said housing couldbe adapted to hold a lubricating fluid for lubricating at least a partof said driving member. Said lubricating fluid is preferably abiocompatible lubricating fluid, such as hyaluronic acid.

FIG. 27 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9, according to an embodiment where said operatingdevice comprises an electrical motor 158. Said electrical motor isconnected to the driving member 30.

FIG. 28 a shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to an embodiment wherein said operatingdevice comprises a hydraulic motor 159, hydraulically connected to ahydraulic power source 160 by means of a hydraulic power transportsystem 161.

FIG. 28 b shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to an embodiment wherein said operatingdevice comprises a hydraulic motor, but wherein the hydraulic powertransport system is located substantially perpendicular to the holecreation direction.

FIG. 29 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to an eleventh embodiment wherein saidinstrument further comprises at least one of: at least one camera 163,at least one light source 164, at least one measurement device formeasuring the depth of said hole in the pelvic bone or at least onetorque meter 165 for sensing the torque exerted on the driving member 30from the connection with the bone contacting organ 22 and the operatingdevice 23.

FIG. 30 shows the surgical instrument adapted for a first applicationwherein said instrument is an instrument for creating a hole 18, 20 inthe pelvic bone 9 according to a twelfth embodiment in which the part ofsaid instrument adapted to be inserted in the human body is covered witha housing 166 for protecting the human body from the parts of thesurgical instrument. The housing 166 could be made of a stiff orflexible material and could have an antibacterial surface. Said hosing166 could be adapted to be used to house the surgical instrumentaccording to any of the embodiments.

FIG. 31 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for holding a mechanicalelement which according to this embodiment is a reamer adapted to reamthe acetabulum or and/or the caput femur. According to one embodimentthe reamer could be adapted to be expandable. The expandable reamercomprises at least one reaming blade 40 which comprises a reamingsurface 41 a,b. Said expandable reamer could be adapted to ream theacetabulum 8, the caput femur 5 or both. In the embodiment where saidexpandable reamer is adapted to ream the acetabulum 8 said reamingsurface 41 a is located on the exterior part of the at least one reamingblade 40, whereas in the embodiment when said expandable reamer isadapted to ream the caput femur 5, said reaming surface 41 b is locatedon the interior part of the at least one reaming blade 40. According toa second embodiment said expandable reamer is adapted to ream both theacetabulum and the caput femur, in which case the reamer has reamingsurfaces 41 a,b both on the exterior and the interior part of the atleast one reaming blade 40.

FIG. 32 shows the expandable reamer, according to any of theembodiments, wherein the reaming blades 40 can be folded towards acenter of the semi-sphere that the expandable reamer produces in itsexpanded state, shown in FIG. 21. The folding of the reaming blades 40enables the expandable reamer to be introduced into a hip joint througha hole smaller than the area possible to ream using said expandablereamer.

FIG. 33 shows the interior said of the expandable reamer with thereaming blades 40. In the embodiment when the expandable reamer isadapted to ream the caput femur said interior side of the at least onereaming blade 40 comprises a reaming surface 41 b.

FIG. 34 shows the expandable reamer according to any of the embodimentswhen reaming the acetabulum 8 and/or the caput femur 5. The reamer canbe adapted to be operated manually or by means of a rotating, vibratingor oscillating operating device.

FIG. 35 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a second embodiment wherein theinstrument further comprises a parallel displaced part or section 26.The parallel displaced part or section 26 improves the reach of theinstrument and enables the reaming of the acetabulum and/or the caputfemur through a hole 18 in the pelvic bone 9 from the opposite side fromacetabulum 8. According to the embodiment shown in FIG. 16 the paralleldisplaced part or section 26 has a telescopic function by means of theparallel displaced part or section 26 being divided in to a first andsecond part 27 a, b, wherein the second part 27 b can slide in and outof the first part 27 a.

FIG. 36 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a third embodiment wherein saidinstrument comprises a driving member 28 a,b,c with two angle adjustingmembers 29 a,b. The angle adjusting members 29 a,b could be adjustablefor varying the angle of said driving member 28 a,b,c or fixed in anangle suitable for reaming the acetabulum and/or the caput femur througha hole in the pelvic bone 9 from the opposite side from acetabulum 8.

FIG. 37 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a fourth embodiment wherein thedriving member 30 is flexible, enabling said driving member 30 to bevery precisely adjusted to ream the acetabulum and/or the caput femurthrough a hole 18 in the pelvic bone 9 of the patient. The stiffness ofsaid driving member 30 could range from completely flexible tocompletely stiff to fit the surroundings of the particular operation.

FIG. 38 shows a pneumatic, vacuum powered or a hydraulic transportsystem 152 for transport of the small pieces of bone created whenreaming the acetabulum and/or the caput femur. The same system 152 or anadditional one could be for rinsing or cooling purposes when reaming theacetabulum and/or caput femur. The shown transport system could be addedto the reamer according to any of the embodiments.

FIG. 39 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a fifth embodiment, wherein thedriving member 30 comprises at least one worm gear 153 which enables thedriving member 30 to be angled. It is also conceivable that said anglecould be adjustable in which case said worm gear has a radius (notshown).

FIG. 40 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to an sixth embodiment, wherein thedriving member 30 comprises at least one gear wheel 154. In theembodiment shown the two gear wheels 154 is constructed to enable theadjusting of an angle of the driving member 30.

FIG. 41 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a seventh embodiment, wherein thedriving member 30 comprises at least one universal joint 155, saiduniversal joint enabling the adjusting of an angle of said drivingmember 30.

FIG. 42 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to an eight embodiment, wherein thedriving member 30 comprises at least one chain 156.

According the any of the embodiments above the driving member couldcomprise a housing 157 shown in FIGS. 23, 24 and 26. Said housing couldbe adapted to hold a lubricating fluid for lubricating at least a partof said driving member. Said lubricating fluid is preferably abiocompatible lubricating fluid, such as hyaluronic acid.

FIG. 43 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulumand/or the caput femur, according to an embodiment where said operatingdevice comprises an electrical motor 158. Said electrical motor isconnected to the driving member 30.

FIG. 44 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulumand/or the caput femur, according to an embodiment wherein saidoperating device comprises a hydraulic motor 159, hydraulicallyconnected to a hydraulic power source 160 by means of a hydraulic powertransport system 161.

FIG. 45 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to an embodiment wherein saidoperating device comprises a hydraulic motor, but wherein the hydraulicpower transport system is located substantially perpendicular to thehole creation direction.

FIG. 46 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a ninth embodiment wherein saidinstrument further comprises at least one of: at least one camera 163,at least one light source 164, at least one measurement device formeasuring the depth of said hole in the pelvic bone or at least onetorque meter 165 for sensing the torque exerted on the driving member 30from the connection with the reaming organ and the operating device 23.

FIG. 47 shows the surgical instrument adapted for a second applicationwherein said instrument is an instrument for reaming the acetabulum orand/or the caput femur, according to a tenth embodiment in which thepart of said instrument adapted to be inserted in the human body iscovered with a housing 166 for protecting the human body from the partsof the surgical instrument, and the surgical instrument from the humanbody. The housing 166 could be made of a stiff or flexible material andcould have an antibacterial surface. Said hosing 166 could be adapted tobe used to house the surgical instrument according to any of theembodiments.

FIG. 48 shows the surgical instrument adapted for a third, a fourthand/or a fifth application wherein said instrument is an instrument forflushing, cooling and/or sucking an affected area during an operationfor treating hip joint osteoarthritis in a human patient. A member forflushing, cooling and/or sucking 400 is positioned on the proximal partof a hydraulic or pneumatic transportation system 404 comprising onepressure tube 401 and one suction tube 402. In the application where thesurgical instrument is used for flushing only, it is conceivable thatthe hydraulic or pneumatic transportation system 404 only comprises apressure tube. Furthermore the surgical instrument according to thethird application comprises a unit 403 that could comprise at least oneof a pneumatic or hydraulic pumping device 405, a cooling member 406, afilter device 407 and an energy accumulating or transforming unit 408.The portions of the instruments adapted to be placed in the abdominalarea are the abdominal portions 250, and the portions adapted to atleast partially be placed inside of the pelvic bone is the pelvicportions 251 throughout this application.

FIG. 49 shows the surgical instrument adapted for a sixth application,wherein said instrument is an instrument comprising a mechanical elementadapted to insert a prosthesis, a prosthetic parts or parts needed tocreate or provide a hip joint surface, according to a first embodimentwherein the surgical instrument comprises a gripping portion 76 and ahandling portion 77. According to the embodiments shown in FIG. 49 theinstrument further comprises a rotation element 78 that enables thegripping part 76 to rotate in relation to the handling part 77, howeverit is equally conceivable that the surgical instrument lacks thisrotation element 78.

According to other embodiments the mechanical element comprises aprosthesis or prosthetic part for insertion in the human body.

FIG. 50 shows the surgical instrument adapted for a sixth application,wherein said instrument is an instrument adapted to insert a prosthesis,prosthetic parts or parts needed to create or provide a hip jointsurface, according to a second embodiment. According to this embodimentthe surgical instrument 412 further comprises a parallel displacedsection 79, which increases the reach of the surgical instrument 412 andfacilitates the reaching of the hip joint through a hole in the pelvicbone from the opposite side from acetabulum.

FIG. 51 shows the surgical instrument adapted for a sixth application,wherein said instrument is an instrument adapted to insert a prosthesis,prosthetic parts or parts needed to create or provide a hip jointsurface, according to a third embodiment. According to this embodimentthe surgical instrument 412 further comprises two angle adjustingmembers 80 a,b. The angle adjusting members could be adjustable forvarying the angle of said gripping part 76 in relation to the handlingportion 77, or fixed in an angle suitable for creating operating in ahip joint through a hole in the pelvic bone from the opposite side fromacetabulum 8.

FIG. 52 shows the hip joint in section after the artificial caput femursurface 45, and the artificial acetabulum surface 65 have been provided.

FIG. 53 shows the surgical instrument adapted for a sixth application,wherein said surgical instrument 412 is a surgical instrument 412adapted to insert a prosthesis, prosthetic parts 46, 48 or parts neededto create or provide a hip joint surface when being used by a surgeon toinsert a prosthesis, prosthetic parts 46, 48 or parts needed to createor provide a hip joint surface through an opening in said human body.

FIG. 54 shows a prosthesis, prosthetic parts 48 or parts needed tocreate or provide a hip joint surface inserted through laparoscopictrocars 33 a,b,c, through a small incision according to a laparoscopicmethod. The artificial hip joint surface parts 48 or the artificialcaput femur surface parts 46 are adapted to be connected to each otherafter the insertion to form an artificial hip joint surface.

FIG. 55 shows how an expandable artificial caput femur surface 45 isbeing inserted through a hole 18 in the pelvic bone 9, using saidsurgical instrument 412.

FIG. 56 a shows the hip joint in section with a hole 18 in the pelvicbone 9. An artificial caput femur surface 45 is introduced into the hipjoint through the hole 18 in the pelvic bone 9 form the opposite sidefrom acetabulum 8. The artificial caput femur surface parts 46 areconnected to each other after insertion into the hip joint to form theartificial caput femur surface 45.

FIG. 56 b shows the hip joint in section when the artificial caput femursurface parts 46 are connected to each other using the surgicalinstrument adapted for the sixth application. According to thisembodiment the artificial caput femur surface parts 46 are adapted tosupply a form fitting 47 that enables the parts to connect to each otherwithout the use of any adhesive or additional mechanical parts. Thesurgical instrument adapted for the sixth application is adapted to beinserted through a hole 18 in the pelvic bone 9 and connecting said atleast two hip joint surface parts 46 to each other. FIG. 56 b shows theartificial caput femur surface parts, however it is equally conceivablethat the artificial hip joint surface parts are artificial acetabulumsurface parts. The surgical instrument 413 could comprise at least onegripping member 414, for gripping in the hip joint. The gripping member414 could be powered by hydraulic, pneumatic or electrical energy. Thegripping member 414 or otherwise part being in connection with saidartificial hip joint surface parts is in connection with a handling part416 through a connecting member 415, which could be bent or otherwiseadapted to improve the reach of the surgeon for operating in a hip jointthrough a hole 18 in the pelvic bone 9 of a human patient.

FIG. 56 c shows the artificial caput femur surface parts 46 with theparts supplying the form fitting 47.

FIG. 57 shows the surgical instrument adapted for a seventh application,wherein the surgical instrument 416 is adapted to fixate a hip jointsurface 45 to the caput femur 5 through a hole 18 in the pelvic bone 9.According to the embodiment shown in FIG. 57 the surgical instrument 416is adapted to fixate an artificial caput femur surface, however it isequally conceivable that the surgical instrument 416 is adapted tofixate an artificial acetabulum surface to the pelvic bone 9. Thefixation could be done by means of screws, form fitting, welding,adhesive, sprint, band, or other mechanical connecting members. Thesurgical instrument 416 in FIG. 57 further comprises a member forproviding rotational force 417 which could be used to fixate anartificial hip joint surface with screws or other rotation fixationmembers. The proximal part of the surgical instrument 416 could howeveralso be equipped with a welding electrode, or a tool for fixatingartificial hip joint surface using sprint or band.

FIG. 58 shows the surgical instrument adapted for a seventh application,wherein the surgical instrument 416 is adapted to fixate a hip jointsurface 45 to the caput femur 5 through a hole 18 in the pelvic bone 9.According to this embodiment the surgical instrument 418 is a surgicalinstrument 418 adapted to fixate an artificial caput femur surface 45 tothe caput femur 5 using bone cement or adhesive. According to thisembodiment the surgical instrument 418 comprises a hollow space 419 forhousing the fluid 419 such as bone cement or adhesive to be used in thefixation of the artificial hip joint surface. A piston part 420 suppliesthe pressure to the fluid 419 and pushes it through an injecting tip422. The piston part 420 is powered or manually operated via a force rod421 which could be flexible for improved reach.

FIG. 59 a shows the surgical instrument adapted for an eight applicationwherein the instrument is adapted for placing a mould or a first and/orsecond sealing member in the hip joint through a hole in the pelvicbone, the femur bone or the hip joint capsule. The mould or sealingmember could be used to create an artificial hip joint surface inside ofthe hip joint. The surgical instrument 423 comprises a piston 89 fortransporting said mould or first and/or second sealing member into thehip joint and a tube like element 90 for housing of said mould or firstand/or second sealing member.

FIG. 59 b shows a section of the surgical instrument 413 comprising thetube like element 90 for housing of said mould or first and/or secondsealing member

FIG. 59 c shows the surgical instrument 413 according to anotherembodiment in which the surgical instrument 413 comprises a flexible orbent part 91 improving the reach of the surgical instrument 413. Thesurgical instrument 413 according to any of the embodiments can be usedto place said mould or first or second sealing members inside of the hipjoint in any of the ways described in the following embodiments.

FIG. 60 a shows the surgical instrument 423 adapted to insert the mouldor first and/or second sealing member in the hip joint, according to asecond embodiment. According to this embodiment the surgical instrument423 comprises a gripping portion 76 and a handling portion 77. Accordingto the embodiments shown in FIG. 60 a,b,c the surgical instrument 423further comprises a rotation element 78 that enables the gripping part76 to rotate in relation to the handling part 77, however it is equallyconceivable that the surgical instrument 423 lacks this rotation element78.

FIG. 60 b shows the surgical instrument 423 adapted to insert the mouldor first and/or second sealing member in the hip joint, according to athird embodiment. According to this embodiment the surgical instrumentfurther comprises a parallel displaced section 79, which increases thereach of the surgical instrument 423 and facilitates the reaching of thehip joint through a hole 18 in the pelvic bone 9, the femoral bone orthe hip joint capsule.

FIG. 60 c shows the surgical instrument 423 adapted to insert the mouldor first and/or second sealing member in the hip joint, according to athird embodiment. According to this embodiment the surgical instrument423 further comprises two angle adjusting members 80 a,b. The angleadjusting members 80 a,b could be adjustable for varying the angle ofsaid gripping part 76 in relation to the handling portion 77, or fixedin an angle suitable for operating in a hip joint through a hole 18 inthe pelvic bone 9, the femur bone or the hip joint capsule.

FIG. 61 shows the hip joint in section wherein a mould or a firstsealing member 84 is inserted through a hole 18 in the pelvic bone 9using an instrument adapted therefor 85. The step of placing said mouldor first sealing member 84 can be performed in a surgical, or in alaparoscopic method.

FIG. 62 shows the hip joint in section wherein a second sealing member86 is inserted through a hole in the pelvic bone 9 in a surgical or alaparoscopic method. The first 84 and second 86 sealing members createsa sealed space 87 between the acetabulum 8 and the caput femur 5 adaptedto be used as a mould for providing an artificial acetabulum 65 and/or acaput femur surface 45.

FIG. 63 a,b,c shows an alternative approach to placing said mould orfirst sealing member 84 in the hip joint of a human patient. Saidalternative approach comprises the steps of creating a hole 82 in thefemur bone 7 following a length axis of the collum femur 6, as shown inFIG. 63 a, said hole starting from the lateral side of the thigh,penetrating the cortex of the femur bone 7 and eventually reaching thecortex of the caput femur 5 from the inside thereof, penetrating saidcortex and entering into the hip joint. After the creation of the hole82 in the femur bone 7 the mould or first sealing member 84 is insertedinto the hip joint through the hole 82 using a surgical instrument 88adapted therefor, as shown in FIG. 63 c. This approach could also beused for placing a second sealing member 86 in pelvic bone 9 or thefemur bone 7 through the hole 82 in the femur bone 7.

FIG. 64 shows a third approach to the placing of a mould or a firstsealing member 84 inside of the hip joint. According to this approachthe first sealing 84 member is placed in the hip joint through the hipjoint capsule 12.

It is furthermore conceivable that the first sealing member 84 is placedin the hip joint using any of the approaches above, whereas the secondsealing member 86 is placed in the hip joint using another of theapproaches above.

FIG. 65 shows the surgical instrument adapted for a ninth application,wherein the surgical instrument is an injecting member 92 adapted toinject a fluid 93 into a mould or sealed area 81 in the hip jointthrough a hole 18 in the pelvic bone 9 from the opposite side fromacetabulum 8. The injecting member 92 comprises a piston 94 that pushessaid fluid 93 into the mould 81.

FIG. 66 shows the hip joint in section wherein an injecting member 92injects a fluid 93 into a mould 81 or a sealed area in the hip jointthrough a hole 82 in the femur bone 7. The injecting member 92 comprisesa piston 94 that pushes said fluid 93 into the mould 81.

FIG. 67 shows the hip joint in section wherein an injecting memberinjects a fluid 93 into a mould 81 in the hip joint through a hole inthe hip joint capsule 12. The injecting member 92 comprises a piston 94that pushes said fluid 93 into the mould 81. Said fluid 93 being adaptedto harden to create a medical device adapted to serve as at least oneartificial hip joint surface.

FIG. 68 shows the hip joint in section wherein the medical device 93′ islocated between the acetabulum 8 and the caput femur 5 which has beencreated by the hardening of the fluid 93 adapted to harden. Said medicaldevice is adapted to serve as at least one artificial hip joint surface.The hole in the pelvic bone is preferably sealed with a bone plug 31 ora prosthetic part 98. The mould 81 used to create the medical device 93′has been resorbed by the human body. According to another embodiment themould used to create the medical device 93′ has melted.

FIG. 69 shows a lateral section of the human body wherein an injectingmember 92 injects a fluid into a mould 81 or a sealed area in the hipjoint through a hole 18 in the pelvic bone 9 from the opposite side fromacetabulum 8. The injecting member penetrates the skin 300 of the humanpatient in a surgical or laparoscopic method.

FIG. 70 shows the injecting member 92 according to any of theembodiments above, adapted to inject fluid 93 into a mould 81 in the hipjoint. The injecting member 92 could further be adapted to injectmaterial 93 or a fluid 93 into a connecting area between the pelvic bone9 and a prosthetic part, the pelvic bone 9 and a bone plug 31 or thecaput femur 5 and a prosthetic part. Said injecting member 92 comprisesa container 107 adapted to hold a fluid 93 for injection. According to afirst embodiment said container 107 comprises two compartments 108 a,badapted to hold two different fluids, said fluids being adapted toharden when mixed. In the embodiment when the container 107 is adaptedto hold two fluids, it is conceivable that the injecting member 105further comprises a mixing member 109 wherein said two fluids are beingmixed before injection. According to a second embodiment (not shown)said container 107 is adapted to keep said fluid sterile. According to athird embodiment (not shown) said container 107 is adapted to keep saidfluid cold or hot and according to a fourth embodiment (not shown) saidcontainer 107 is adapted to keep said fluid in a dark environment.Furthermore a combination of the above mentioned embodiments isconceivable.

According to another embodiment (not shown) the fluid is adapted toharden through the mixing with a gas. In which case one of the twocompartments is adapted to hold a pressurized gas (such as nitrogen gas)adapted to act as catalyzing agent for the fluid adapted to harden.According to that embodiment the mixing unit 109 is adapted to mix oneliquid and one gas fluid. Said first, second or mixed fluid could alsobe adapted to harden by means of UV-light, thermic change or contactwith a body fluid.

According to a tenth application the surgical instrument is adapted toassist in the placing of a bone plug or prosthetic part for sealing thehole in the pelvic bone created to reach the hip joint from theabdominal side of the pelvic bone.

FIG. 71 a shows a prosthetic part 98 being inserted into a hole 18 inthe pelvic bone 9 from the opposite side from acetabulum 8. According toone embodiment the prosthetic part 98 comprises supporting members 99adapted to correspond with sections 100 of the hole 18 in the pelvicbone 9. After the prosthetic part 98 has been inserted using saidsurgical instrument it is rotated so that the supporting members 99comes in contact with the pelvic bone 9 and can carry the load placed onthe acetabulum 8 from weight of the human patient through the contactwith the caput femur 5. Said prosthetic part 98 could also be adapted toserve as artificial acetabulum surface 65 according to any of the abovementioned embodiments.

FIG. 71 b shows the prosthetic part 98 when rotated to carry the loadplaced on the acetabulum 8 from weight of the human patient through thecontact with the caput femur 5.

FIG. 72 shows the hip joint of a human patient in section wherein theprosthetic part 98 closes the hole 18 in the pelvic bone 9 and carriesthe load placed on the acetabulum 8 from weight of the human patientthrough the contact with the caput femur 5 by means of the supportingmembers 99. The prosthetic part 98 can further be fixated to the pelvicbone 9 by means of bone cement, adhesive, screws, form fitting, welding,sprints, band or some other mechanical connecting member.

FIG. 73 shows the hip joint of a human patient in section wherein boneplug 31 or prosthetic part 98 is attached to the pelvic bone 9 by meansof screws 101 placed from the opposite side from acetabulum 8. Thescrews 101 are possible to place in different angles depending on reachor need for support.

According to an eleventh application the surgical instrument is adaptedto assist in the fixation of a bone plug or prosthetic part for sealingthe hole in the pelvic bone created to reach the hip joint from theabdominal side of the pelvic bone

FIG. 74 a shows the hip joint of a human patient in section wherein thesurgical instrument 424 is adapted to place screws 103 bone fixating aplate 102 that at least partly covers said bone plug 31 or prostheticpart 98. According to a first embodiment the surgical instrument 424comprises a flexible part or section 426 that improves the reach of saidsurgical instrument 424. The surgical instrument 424 further comprisesan operating device 425 that supplies rotational force to the surgicalinstrument for fixating the screws 103.

FIG. 74 b shows the surgical instrument 424 according to a secondembodiment wherein said surgical instrument comprises a paralleldisplaced part or section 427 the improves the reach of said surgicalinstrument 424.

FIG. 74 c shows the surgical instrument 424 according to a thirdembodiment wherein said surgical instrument comprises two angleadjusting members 428 that improves the reach of said surgicalinstrument 424.

In the above mentioned embodiments the plate 102 and/or the bone plug 31or prosthetic part 98 are fixated be means of screws 103, however it isequally conceivable that said screws 103 can be replaced or assisted bybone cement, adhesive, form fitting, welding, sprints, band or someother mechanical connecting member.

FIG. 75 shows the surgical instrument adapted for an eleventhapplication wherein said surgical instrument 434 is an arthroscopiccamera adapted to be inserted into the hip joint through a hole 18 inthe pelvic bone from the abdominal side thereof. It is also conceivablethat said surgical instrument 434 is a light source (not shown) or andevice for performing x-ray of the hip joint (not shown).

FIG. 76 shows a twelfth application. The surgical instrument 492 isadapted to inject a lubricating fluid into the hip joint, through a hole18 in the pelvic bone 9. Said lubricating fluid is preferably abiocompatible lubricating fluid such as hyaluronic acid. The surgicalinstrument 492 comprises a container 493 and a fluid transporting member494 for transporting said fluid from the container 493 to the injectingmember 495, which is the proximal part of said fluid transportingmember. The portions of the instruments adapted to be placed in theabdominal area are the abdominal portions 250, and the portions adaptedto at least partially be placed inside of the pelvic bone is the pelvicportions 251 throughout this application.

Please note that any embodiment or part of embodiment, feature, method,associated system, part of system described herein may be combined inany way.

The invention claimed is:
 1. A surgical instrument for operating hipjoint osteoarthritis in a human patient, a hip joint comprising anacetabulum, the acetabulum being a part of a pelvic bone, and a caputfemur, the caput femur being a proximal part of a femoral bone, whereinsaid surgical instrument is adapted to assist in the operating of thehip joint osteoarthritis from an abdominal side of the pelvic bone ofsaid human patient, said surgical instrument comprising: an abdominalportion insertable through an incision in a skin in an abdominal regionand adapted to be placed between the incision in the abdominal regionand the pelvic bone when the instrument is in use, and a pelvic portionconnected to the abdominal portion, being partially insertable through ahole in the pelvic bone from the abdominal side of the pelvic bone, whenthe instrument is in use, wherein a portion of the pelvic portion isadapted to operate at least partially in a surgically created hole inthe pelvic bone, and a reamer connected to the pelvic portion and beingadapted to at least one of ream the acetabulum of said human patient,ream the caput femur of said human patient, and ream both theacetabulurn and the caput femur of said human patient, wherein saidreamer is expandable, thus allowing said surgical instrument to beinserted through a hole in the pelvic bone smaller than the areapossible to ream using said surgical instrument, and an angle adjustingmember for adjusting the angle between the reamer and the abdominalportion, and wherein the abdominal portion is more than 100 mm, suchthat the abdominal portion can reach from the incision in the abdominalregion to an area of the hip joint opposite the acetabulum.
 2. Thesurgical instrument according to claim 1, wherein said surgicalinstrument comprises a bend between said abdominal portion and saidpelvic portion.
 3. The surgical instrument according to claim 1, furthercomprising a gripping end for handling of the instrument, wherein saidgripping end is connected to the abdominal portion and adapted to remainoutside the skin of the patient when the instrument is in use, wherein aportion between the gripping end and a bend is at least 100 mm such thatthe bend can be placed at the pelvic bone on the opposite side fromacetabulum.
 4. The surgical instrument according to claim 1, furthercomprising a gripping end for handling of the instrument, wherein saidgripping end is connected to the abdominal portion and adapted to remainoutside the skin of the patient when the instrument is in use, wherein aportion between the gripping end and a bend is at least 200 mm such thatthe instrument can operate inside of the hip joint from the abdominalside of the pelvic bone.
 5. The surgical instrument according to claim1, wherein the surgical instrument is a laparoscopic instrument adaptedto be inserted through the skin of the abdominal region through alaparoscopic port.
 6. The surgical instrument according to claim 1,wherein the surgical instrument is a laparoscopic instrument introducedinto the abdomen and further down to the pelvic bone on the oppositeside of the acetabulum and introduced into the hip joint, furthercomprising a gripping end, placed outside the abdominal wall when inuse, and a hip joint end adapted to be placed in an area of the hipjoint, wherein the length of said instrument is adapted to reach fromthe gripping end and into the hip joint via a surgically created hole inthe pelvic bone and wherein the longitudinal extension of saidinstrument comprises at least one bend, for the instrument to reach,when used as a laparoscopic instrument to operate the hip joint, fromthe gripping end into the abdomen and further down to the pelvic bone onthe opposite side of the acetabulum and be introduced into the hip jointthrough the surgically created hole in the pelvic bone.
 7. The surgicalinstrument according to claim 1, wherein the surgical instrument is apelvic instrument introduced into the pelvic region and further to thepelvic bone on the opposite side of the acetabulum, and introduced intothe hip joint via a surgically created hole in the pelvic bone, furthercomprising a gripping end, placed outside the skin above the pelvicregion when in use, and a hip joint end adapted to be placed in an areaof the hip joint, wherein a length of said instrument is adapted toreach from the gripping end and into the hip joint, and wherein alongitudinal extension of said instrument comprises at least one bend,for the instrument to reach, when used as a pelvic instrument to operatethe hip joint, from the gripping end into the pelvic region and furtherdown to the pelvic bone on the opposite side of the acetabulum, andintroduced into the hip joint through the surgically created hole in thepelvic bone.
 8. The surgical instrument according to claim 1, whereinthe surgical instrument is a retroperitoneal instrument introduced intothe body just above the inguinal region following the pelvic bone downto the opposite side of the acetabulum and thereafter introduced intothe hip joint via a surgically created hole in the pelvic bone, furthercomprising a gripping end, placed outside the skin above the pelvicregion when in use, and a hip joint end adapted to be placed in an areaof the hip joint, wherein a length of said instrument is adapted toreach from the gripping end and into the hip joint and wherein alongitudinal extension of said instrument comprises at least one bend,for the instrument to reach, when used as retroperitoneal instrument tooperate the hip joint, from the gripping end following the pelvic boneand further down to the pelvic bone on an opposite side of theacetabulum and introduced into the hip joint through the surgicallycreated hole in the pelvic bone.
 9. The surgical instrument according toclaim 1, wherein said instrument further comprises at least one holdingportion connected to the pelvic portion, and at least one mechanicalelement adapted to be fitted to said at least one holding portion ofsaid instrument, wherein said mechanical element is adapted to perform afunction during an operation of the hip joint, wherein said mechanicalelement is adapted to be part of an instrument adapted to be used for atleast one of the following functions; drilling, reaming, cooling,heating, flushing, introducing a fluid, sucking, inserting at least onepart, connecting at least one part, fixating at least one part,inserting a mould, filling a mould, injecting, lubricating, viewing,optically displaying, placing screws, placing adhesive, and placing bonecement.
 10. The surgical instrument according to claim 6, wherein thedistance between the gripping end and the bend is at least one of; atleast 150 mm, at least 200 mm, at least 300 mm, at least 400 mm, and atleast 500 mm.
 11. The surgical instrument according to claim 2, whereinsaid bend is bent with an angle of at least one of; at least 10 degrees,at least 20 degrees, at least 30 degrees, at least 40 degrees, at least50 degrees, and at least 60 degrees.
 12. The surgical instrumentaccording to claim 2, wherein the distance between said bend and thepelvic portion of the instrument is at least one of at least 20 mm, atleast 40 mm, at least 60 mm, at least 80 mm, at least 100 mm, at least120 mm, and at least 140 mm.
 13. The surgical instrument according toclaim 1, wherein said surgical instrument further comprising at leastone camera.
 14. The surgical instrument according to claim 1, whereinsaid surgical instrument further comprising at least one light source.15. The surgical instrument according to claim 1, wherein said surgicalinstrument is adapted to at least one of: introduce a prosthesis throughthe hole in the pelvic bone and into the hip joint, connect at least twoprosthetic parts to each other after insertion into the hip joint,fixate an artificial hip joint surface, or a part of an artificial hipjoint surface, to the pelvic bone or the femoral bone, and place orfixate fixating elements to the pelvic bone or a prosthetic part in thehip region or the pelvic bone region.
 16. The surgical instrumentaccording to any one of claims 1, wherein said surgical instrument isadapted to at least one of; cool an area of the hip joint or an area ofthe pelvic bone, provide a fluid to an area of the pelvic bone or thehip joint, and provide suction to an area of the pelvic bone or an areaof the hip joint, introduce a mould into the hip joint, inject a fluidinto a mould placed in the hip joint, introduce adhesive into the hipjoint, inject a lubricating fluid into the hip joint, said surgicalinstrument comprising at least one container, a fluid injecting member,and a fluid driving member in fluid connection with said fluid injectingmember and said at least one container.